Do we actually need to anesthetize the neonate?

Abstract

In this issue of Pediatric Anesthesia, authors discuss several key aspects of the theory and practice of neonatal anesthesia. Recurring themes are that neonatal physiology is substantially different to older children, that there are substantial gaps in our understanding of basic pharmacology and physiology, and there is a relative paucity of strong clinical evidence to guide practice. There are more questions than answers.

One fundamental question is do we actually need to anesthetize the neonate? Until relatively recently, neonates received little in the way of anesthesia due to concerns about their physiological capacity to survive the depressant effects of anesthetics and a belief that neonates have less capacity to feel pain. While we can still argue about what a neonate ‘feels,’ it is clear that neonates do respond adversely to nociceptive stimuli. Painful stimuli result in structural changes in the spinal cord, and untreated pain has adverse long-term consequences. Good pain relief not only improves outcome, it is now regarded as a basic human right, and there is no reason why this right should not be extended to the neonate. But anesthesia is more than just pain relief. Do they need to be anesthetized?